Objective:To review the treatment of life threatening head and neck space infection.Methods:Retrospective was con-ducted to analyse the patient characterization,signs and symptoms at the time of presentation,presence of concomitant systemic co-morbidities,treatment,prognosis and bacteriology.Results:32 patients from 2007.01 to 2013.01(mean age was 57.71 years)were included.The cases were increased year by year.1 1 (34.37%)patients had breathing difficulty requiring tracheostomy and 19 (59.3%)had concomitant systemic comorbidities.23 cases recovered completely,8 with severe mediastinal infection were trans-ferred to the department of thoracic surgery or the department of respiratory medicine.1 patient died.Pus submission rate was 96.87%,the bacteria detection rate was 37.50%.Pus culture showed mixed infection dominated by streptococci.Staphylococcus au-reus,pseudomonas aeruginosa,enterococcus faecalis,prevotella and neisseria were detected.Conclusion:Annually incidence of life threatening head and neck space infection is increasing.Treatment of the infection should include:①Ensuring the airway patency;②Surgical incision and drainage as early as possible;③ Hypoglycemic control,maintenance of hemodynamic,nutritional support,and multi-disciplinary approach are the key points in the management of such infections;④ Systemic antibiotics.

OBJECTIVETo review the outcomes of three different methods of maxillomandibular advancement for the treatment of severe obstructive sleep apnea-hypopnea syndrome (OSAHS).

METHODSTwenty-four patients with severe OSAHS from January 2011 to January 2014 treated by three different methods of maxillomandibular advancement (MMA) and genioplasty, maxillomandibular advancement without rotation plus genioplasty, maxillomandibular advancement with counterclockwise rotation plus advancement genioplasty, maxillomandibular advancement with first premolars extraction and subapical osteotomy setback under general anesthesia were included in the study. Comparison of per-operative and post-operative cephalometric analysis, polysomnography (PSG), apnea and hypopea index (AHI), body mass index (BMI), average blood oxygen saturation (AOS), lowest oxygen saturation (LSaO2) and posterior airway space (PAS) data were performed. The operative time and post-surgical orthodontic treatment data were collected and analyzed.

RESULTSAccording to Stanford criteria, the success rate of 100% was achieved with all the three methods. The difference between per-operative and post-operative AHI, AOS, SNPg and PAS were statistically significant (P<0.0001) for all the three methods. Significant difference was found between per-operative and post-operative SNA (81.51°±3.36° vs 88.17°±4.51°, P<0.0001), (82.25°±2.71° vs 86.54°±3.65°, P=0.0002) and SNB (72.37°±3.99° vs 80.59°±3.40°, P<0.0001), (73.65°±3.80° vs 81.37°±2.96°, P<0.0001) among MMA without rotation plus genioplasty and MMA with counterclockwise rotation and advancement genioplasty respectively. However, no significant difference was found between the pre-operative and post-operative SNA (82.18°±4.27° vs 84.19°±2.70°, P=0.2015) and SNB (73.28°±3.04° vs 75.35°±2.56°, P=0.2640) among MMA with first premolars extraction and subapical osteotomy setback. The average duration of postoperative orthodontics treatment was 8.3 months.

CONCLUSIONSMMA and advancement genioplasty is an effective surgical management for severe OSAHS. Cephalometric analysis and computer aided design are needed for personalized surgical methods. MMA without rotation and advancement genioplasty method leads to the protrusive skeletal deformity. MMA with counterclockwise rotation and advancement genioplasty method is effective in curing severe OSAHS with little effect on facial profile. MMA with first premolars extraction and subapical osteotomy requires longer operative time and longer postoperative orthodontic treatment.

Body Mass Index ; Cephalometry ; Genioplasty ; methods ; Humans ; Mandibular Advancement ; methods ; Osteotomy ; methods ; Oxygen ; metabolism ; Polysomnography ; Sleep Apnea, Obstructive ; surgery ; Treatment Outcome